title: Chronic pain after caesarean delivery: an Australian cohort.
abstract: We investigated the incidence of and risk factors for persistent pain after caesarean delivery. Over a 12-month period, women having caesarean delivery were recruited prospectively at an Australian tertiary referral centre. Demographic, anaesthetic and surgical data were collected and at 24 hour follow-up, women were assessed for immediate postoperative pain and preoperative expectations of pain. Long-term telephone follow-up was conducted at two and 12 months postoperatively. Complete data were obtained from 426 of 469 women initially recruited (90.6%). The incidence of persistent pain at the abdominal wound at two months was 14.6% (n=62) but subsequently reduced to 4.2% (n=18) at 12 months. At two months, 33 patients (7.8%) experienced constant or daily pain. At 12 months, five patients (1.1%) continued to have constant or daily pain which was mild. There was no apparent increase in incidence of persistent pain associated with general versus regional anaesthesia (relative risk [RR] 0.89, 95% confidence interval [CI] 0.49 to 1.6); emergency vs elective procedure (RR 0.65, 95% CI 0.39 to 1.07); higher acute pain scores (RR 1.1, 95% CI 0.69 to 1.75); or history of previous caesarean delivery (RR 0.81, 95% CI 0.50 to 1.33). Persistent pain, usually of a mild nature, is reported by some women two months after their caesarean delivery, but by 12 months less than 1% of women had pain requiring analgesia or affecting mood or sleep. All declined a pain clinic review. Clinicians and patients can be reassured that caesarean delivery is unlikely to lead to severe persistent pain in the long-term.
authors.affiliation: Department of Anaesthesia and Pain Management, Nepean Hospital, Penrith, New South Wales.
authors.forename: T T
authors.initials: TT
authors.lastname: Liu
authors.forename: A
authors.initials: A
authors.lastname: Raju
authors.forename: T
authors.initials: T
authors.lastname: Boesel
authors.forename: A M
authors.initials: AM
authors.lastname: Cyna
authors.forename: S G M
authors.initials: SG
authors.lastname: Tan
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000339:Affect / Q000502:physiology; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical; D001315:Australia / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects*; D059350:Chronic Pain / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000209:etiology; D013530:Surgical Wound Infection / Q000150:complications; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: caesarean delivery; chronic pain; postoperative pain